Provider Demographics
NPI:1518939743
Name:ECK, CHARLES ROSS JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROSS
Last Name:ECK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SCHILLING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1191
Mailing Address - Country:US
Mailing Address - Phone:410-771-9220
Mailing Address - Fax:
Practice Address - Street 1:9 SCHILLING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1191
Practice Address - Country:US
Practice Address - Phone:410-771-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D72065Medicare UPIN
2986Medicare ID - Type Unspecified